Order for Hospitals to Remain Open and Staffed During Hurricanes

The Order for Hospitals to Remain Open and Staffed During Hurricanes made hospitals an exception to New Orleans’s mandatory evacuation during Hurricane Katrina: while residents were told to leave, hospitals and their workers were to remain. The policy sought to preserve care for people injured in the storm, but it also left patients and staff inside facilities exposed to flooding, power loss, and a rescue system that could not reliably move them. The book’s account sets the obligation to stay open against the practical limits of hospitals’ emergency preparations and the unequal chances people had of reaching safety.

The evacuation exception

Mayor Ray Nagin’s order instructed residents to leave New Orleans but exempted hospitals and their workers. When asked whether people should stay in hospitals, he explained that injuries during the hurricane would make open hospitals necessary; turning patients away, he warned, could create a dangerous situation. Yet the evacuation plan offered little assurance to people who could not travel independently. The New Orleans Superdome was designated a shelter of last resort, including for people with medical conditions, but officials did not explain what care would be available there.

Keeping hospitals open did not resolve how patients could be moved or supported. Dispatchers at Acadian, the region’s largest ambulance company, were overwhelmed by requests from hospitals, nursing homes, and homes. Many of the roughly two dozen ambulances made available were stuck in interstate traffic, and some delivered patients to the New Orleans Superdome rather than attempting to take them out of the city. The exception therefore operated amid a wider evacuation bottleneck: facilities were expected to receive or retain people while transport capacity was already constrained.

Memorial under the obligation to stay

At Memorial Medical Center, the anticipated flood forced staff to prepare for a crisis they could not manage alone. ICU nurse manager Karen Wynn recalled that when Susan Mulderick announced that floodwaters were coming, the command room’s atmosphere shifted from a hospital emergency to a military operation, focused on acting before the power failed. Nearly two hundred patients needed protection. The initial proposal was to evacuate the sickest first, including intensive-care patients, newborns, high-risk pregnant patients, dialysis patients, and two especially infection-vulnerable bone marrow transplant patients.

The scale of the need exceeded the hospital’s available resources. Mulderick sought more ambulances and helicopters from Acadian and contacted her former husband, who worked for a helicopter-transport company; the company had already been hired to evacuate Tulane Hospital. At Memorial’s helipad, confusion over helicopter capacity became consequential enough that an Air Force captain offered her flight-line experience and was put in charge of clearing the landing area. These episodes show the gap between a requirement to remain staffed and the practical capacity to coordinate safe transfers during a disaster.

The evacuation unfolded in stages rather than as a single departure. By a later phase, boats were taking patients considered well enough to be discharged, along with employees and family members, while patients classified in the highest-priority group waited on the first floor for rescue. Wynn encountered an outpatient who had come through floodwater for a scheduled chemotherapy appointment, unaware that the hospital was no longer providing chemotherapy. The scene captures how an open hospital could remain a destination even when its services and circumstances had radically changed.

Charity Hospital’s contrasting response

Charity Hospital faced severe conditions of its own: flooding, loss of power and functioning plumbing, disrupted communications, and no helipad. It took until the afternoon of September 2 to transfer all its patients, a day later than the completion of the transfer from Memorial Medical Center. The public hospital had approximately twice as many patients across its two campuses as Memorial, with fewer staff per patient; nevertheless, fewer than ten patients died. Its staff continued medical care in patients’ rooms despite the threat and disorder around the evacuation.

The book connects Charity’s response to specific preparations and working practices, not simply to the instruction that hospitals remain open. Officials had drilled for a Category Three hurricane and levee failure, and used federal preparedness funding to obtain portable generators, oxygen-powered ventilators, and ham radios. Staff siphoned gasoline from cars to run ten small generators, powering intensive-care ventilators and cardiac monitors, including those supporting a very premature baby. At Memorial, by contrast, patients had to be ventilated by hand with Ambu bags after power failed; two similar generators were later used for lights and fans in shared areas and at the helipad, rather than for medical equipment.

Charity also held meetings every four hours, maintained ordinary services such as physical and occupational therapy, encouraged regular work shifts and sleep, and actively checked rumors. A flashlight-lit talent show offered another way to maintain morale. Most consequentially for evacuation triage, Charity did not designate a group of patients too ill to rescue: its sickest patients were taken out first. These details make clear that keeping a hospital staffed was not, by itself, a plan for sustaining care. Equipment, practiced procedures, communication, and evacuation priorities shaped what the obligation meant in practice.

The rule’s wider implications

The investigation after Katrina treated the instruction to keep hospitals open and staffed as part of the conditions surrounding patient deaths. The mayor’s evacuation order had not applied to hospitals, which had been told to remain open; that context mattered alongside hospitals’ own preparedness and the failures of transport and rescue. The book’s broader account identifies delayed evacuation, shortages of buses and drivers, poor communications, and inadequate backup power and water as interlocking sources of risk rather than isolating hospital decisions from the emergency around them.

A later account of hurricane planning in the New York region offers a limited contrast: a nonprofit hospital parent had a local command center and was assisting its own facilities and others, unlike the support that Tenet and LifeCare headquarters had provided during Katrina. Yet staff there had still not considered what to do if backup systems also failed. The comparison reinforces the book’s central distinction: an order to stay open establishes an expectation, but does not ensure that a hospital can function, evacuate patients, or obtain support when its ordinary systems and backup plans are overwhelmed.